Leaving Addicts to Fend for Themselves

This blog post was originally published as a Guest Commentary by The Westerly Sun on March 6, 2015. In August 2018, The Westerly Sun was sold to Rhode Island Suburban Newspapers, and previously published content is no longer available online.

Considered by the World Health Organization to be one of the most important medications needed in a basic health system, Narcan prevents or reverses the effects of opioids, including respiratory depression, sedation, and hypotension. To expect an opiate-addicted individual, regardless of prescription or illicit in nature, to be recovered after a single dose of Narcan and an overnight stay in the ICU is akin to putting pressure on a bullet wound.
It’s the proper first step, vital to the victim’s survival, but not the conclusive solution for the malady. And yet all too often, this is the proposed method of treatment for an opiate addict, before being released to the outside world, a cursory aftercare referral clutched in hand, if that person is lucky.

However, even if a social worker or case manager is given an opportunity to provide a referral to a higher level of care, the chances of the patient getting placed on the beginning of the path to recovery are slim. Currently in Westerly, the extent of treatment for those struggling with heroin and other opiate addiction could undoubtedly be improved.

There are three options for opiate-specific addiction treatment in Westerly. Westerly Behavioral Health, (where Dr. Robin and Dr. Curtice provide Suboxone treatment), Dr. Lisa Noyes-Duguay, another Suboxone provider, and The Journey to Hope, Health, & Healing, a methadone-maintenance treatment facility. The population of Westerly was 22,787 at the 2010 census, and while there are no current statistics on the number of opiate addicts currently residing in the town via survey research, the State of Rhode Island Department of Health imposes limitations on the number of methadone patients that can be treated within a facility based on the number of dosing windows, counselors, and nurses the program has, while Suboxone providers are limited to 100 patients under national licensing. Subsequently, there are individuals treated for overdoses at the Westerly Hospital that will never receive a referral for aftercare at one of these medication-assisted treatment options. This fissure in the system is devastating, and it is costing people their lives.

I first took notice of the Shine A Light on Heroin (SALOH) initiative when I saw the Westerly Sun coverage of Jim Spellman’s Easy Chair Interview. I was encouraged by SALOH’s existence, and immediately motivated by a desire to contribute to the cause. When I reached out to Mr. Spellman, he explained to me that he started the organization with several of his friends after attending numerous funerals of former students in the past year. We spoke about my background working in a detox, Suboxone and methadone clinics, and currently an inpatient psychiatric unit, and our feelings as to why the heroin epidemic seems to be gaining traction, and will undoubtedly persist if nothing changes. There are currently no Vivitrol providers in Westerly, and the closest provider in the state is 30 miles away, at Meadow’s Edge Recovery Center in North Kingstown. In the other direction, Serenity Behavioral Health of Groton will provide Vivitrol, however at this time, insurance through R.I. Health Source will not pay for treatment that crosses state lines.

The average person, and sadly even the average addict, has never heard of Vivitrol, despite its tremendous potential as a catalyst to recovery. Vivitrol is an extended-release injectable dose of Naltrexone, allowing the addict a 30-day safety net during which they can put effort into other areas of their recovery via counseling. Vivitrol holds a huge benefit over methadone and Suboxone treatment in that when the individual, in conjunction with his or her provider, feels ready to come off the medication, usually after an average of 15 months, there is no taper process or withdrawal needed. Vivitrol is an opioid receptor antagonist (unlike methadone, which is a synthetic opiate, or Suboxone, a mixed agonist-antagonist opioid receptor modulator), effectively blocking the receptors with little to no side effects for most patients. Vivitrol and Naltrexone (the daily, oral, pill form of the drug) are not habit forming, have zero abuse potential, and very little toxicity.

Essentially, if an addict tries to use on Vivitrol, the euphoric effects of the heroin or pain pill are completely blocked. This holds another huge advantage over methadone and Suboxone; a methadone patient can easily use on methadone by staying on a slightly lower dose and simply using on top of the prescribed drug; for a Suboxone patient, the drawback is it must be taken daily (and not at a clinic in front of a nurse, like methadone) and a patient whose cravings become overwhelming can obtain opioid intoxication simply by skipping a dose or two before resuming opioid use. Vivitrol is also used for alcohol dependence, and studies have confirmed its efficacy in reducing frequency and severity of relapse to drinking, for those with a poly-substance abuse diagnosis. As opposed to other medications used for opioid dependence (methadone and all forms of buprenorphine - Suboxone, Subutex, Zubsolv, & Bunavail), naltrexone can be prescribed by any individual who is licensed to prescribe medicine. This makes the fact that doctors in Westerly are not providing this treatment even more shocking. Both the oral daily form and the monthly injectable monthly extended-release form are FDA approved for treatment of opioid dependence.

On January 28, the Huffington Post ran an article entitled “Dying to be Free,” by Jason Cherkis. A quote from the article reads as follows: “To enter the drug treatment system, such as it is, requires a leap of faith. The system operates largely unmoved by the findings of medical science. Peer-reviewed data and evidence-based practices do not govern how rehabilitation facilities work ... Opiates, cocaine and alcohol each affect the brain in different ways, yet drug treatment facilities generally do not distinguish between the addictions. In their one-size-fits-all approach, heroin addicts are treated like any other addicts. And with roughly 90 percent of facilities grounded in the principle of abstinence, that means heroin addicts are systematically denied access to Suboxone and other synthetic opioids.”

I believe that abstinence-only treatment, that may be feasible for alcoholics or cocaine addicts, fails to hold up for opiate addicts. Dr. Mary Jeanne Kreek, who runs the Laboratory of Biology of Addictive Diseases at Rockefeller University in New York City, believes that in an ideal world, doctors would consult with patients and monitor progress to determine whether Suboxone, methadone or some other medical approach stood the best chance of success. She reported to Cherkis that, “all proper prospective studies have shown that more than 90 percent of opiate addicts in abstinence-based treatment return to opiate abuse within one year.” I believe that the recovery community’s best hope is synonymous with the mission of the American Society of Addiction Medicine: increasing access and improving the quality of addiction treatment, educating physicians, other medical professionals, and the public, supporting research and prevention, and promoting the role of physicians in the care of patients with addiction.

We need Vivitrol providers in Westerly, and an expansion of the Suboxone and methadone-maintenance programs that already exist. With expansion, however, comes the threat of poorer quality services. Supporting medication-assisted treatment does no good if the treatment centers don’t hold their patients to the highest standards in getting clean. That is something that worries me about the possibility of changing current SAMHSA (Substance Abuse & Mental Health Services Administration) legislation, which limits physicians to administering Suboxone to 100 patients. If physicians want to rally to raise the number of patients their license allows for, they need to have the set-up and staff to accommodate that. They need mental health counselors to see newer patients weekly, they need to provide group therapy, and frequent drug screening. In short, to hold their patients accountable for their treatment. Giving someone Suboxone and sending them on their way with no treatment intervention is a recipe for having a heroin and illicit Suboxone problem in your town, as patients who know they can get away with continued addictive behaviors will simply sell their scripts to addicts looking to stave off withdrawals and buy their opiate of choice. It will do nothing to raise the number of Suboxone providers, or the number of patients a Suboxone provider can treat; we have to demand quality as well.

Educating the community is what the organization of SALOH set out to do.
I recently debated with an educated medical professional, a psychiatric nurse with a knowledge and history of treating substance abuse patients, about medication-assisted treatment for opiate dependence. I was discussing the benefits of Vivitrol, and its high success rates for recovery, but he quickly wrote it off as, like methadone and Suboxone, a “crutch” in helping get out of the throngs of addiction. I politely asked him if he’d ever broken or sprained an ankle. Did his doctors expect him to walk, unaided out of the hospital without a crutch? Hitting “rock bottom” does no good if that rock bottom is an early grave. Someone who’s given a fighting chance by being Narcanned, given a shot of Vivitrol, or being referred to a methadone or Suboxone clinic can find recovery.

There are treatments proven to work, to save lives, to help bridge the gap between opiate addiction and recovery. Westerly needs our police force to carry, and our pharmacies to stock, Narcan, the opiate overdose antidote proven to bring people back from the brink of death and provide them with a second chance at recovery. We need Vivitrol providers, and the local hospitals to refer recently treated overdose victims to these providers. We need to expand our resources at our local Suboxone and methadone clinics, bringing increased access and improved quality to our medication-assisted options in town. And we need to employ Certified Peer Recovery Specialists in our hospitals and clinics, to provide support for the addicts and their family members in times of crisis. These are all concrete, achievable goals, which as a town, we can accomplish if we work together and stop letting perceived barriers block our resolve. There’s no reason why we can’t continue to “shine a light” onto the darkest parts of our community’s collective struggles, and come out illuminated on the other side.

Christa Quattromani

The writer is a mental health worker in the field of substance abuse and is a representative of the local Shine A Light On Heroin organization.
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Published on January 30, 2019 11:48
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